Surgery: The Past, The Present and The Future

The recent unveiling of a bronze statue of Maharishi Sushrutha at Edinburgh, in Scotland, on 12th June 2026, brought a great sense of pride to all Indians. Sushrutha,^[1] considered as the “Father of surgery” Or “Father of Plastic Surgery”, was a great surgeon who practised surgery with deep knowledge of Anaesthesia, asepsis, and Anatomy, in 600 B.C.E, much before the Western world gave importance to this skill. He pioneered more than 300 surgical procedures and designed his own instruments. When surgical procedures had not been developed yet, he showed the world what reconstructive surgery was! He was a great teacher and imparted wisdom and the code of medical ethics to his students. Sushruta also emphasised the importance of using sterile, high-quality tools when performing surgical procedures. His descriptions of 1120 specific disease entities showcase his deep understanding of various medical conditions. He was the first to attribute mala ria to mosquitoes and link the spread of plague to rats. His monumental thesis, the Samhita^[1-3], stands as the oldest known surgical text, providing a comprehensive exploration of medical practices during his time. Over the years, the skill slowly faded in India due to some taboos and loss of literature and a simultaneous shift of credit by the Western Historiography, which favoured the legacy of Hippocrates and Galen, leaving early Indian medical achievements out of mainstream international textbooks.

It took more than 20 centuries for surgery to evolve again as an important form of treatment. It has evolved from a brutal, rudimentary practice, driven by survival, into a highly precise, technological and minimally invasive medical speciality. Driven by milestones like anaesthesia, germ theory, and robotics, it has transformed from a dangerous, last-resort procedure into a safe, curative cornerstone of modern healthcare.

We are all aware of the struggle to learn surgery through the dissection of bodies to understand the anatomical details, which has brought clarity in surgical procedures. From vivisections to body snatching, throughout the history of anatomical practice, human dissection has occurred in ways that cross the line from progressing medical science to violating the sanctity of the human body. A paradigm shift in ethical attitudes toward human dissection occurred during the reign of the Holy Roman Emperor Frederick II (1194–1250). Together with the decree of Pope Nicholas III, this change led to the official sanctioning of anatomical dissection. As a result, in 1315, Mondino de Liuzzi performed the first publicly documented cadaveric dissection since the era of Herophilus, using the body of an executed criminal. He subsequently documented this landmark event in his seminal work, Anothomia (1316)^[4,5] that became the manual of anatomy for nearly two centuries. The names of Leonardo da Vinci and Vesalius resonate with artistic depictions of human bodies. While Leonardo Da Vinci was infamous for grave robbing, the work of Vesalius was derived from ethically questionable dissection practices, such as the performance of vivisection, the use of executed prisoners’ bodies, in addition to grave robbing.^[4,5] Nevertheless, both contributed immensely to a detailed anatomy of the human body, which paved the way to the learning of physiology.

Due to religious taboos, surgery was performed by barbers for a considerable time. As the interest in anatomy grew, surgery began to be considered as a skill which needed profound anatomical knowledge. John Hunter, an 18th-century surgeon, introduced experimental study to the science of surgery. He tested ancient surgical approaches. He studied the process of healing and transformed the surgery from an empirical craft to a science, and is therefore referred to as the “Father of Scientific Surgery”.^[4] Meticulous dissection, description of surgical planes and steps, and documentation of results interested the surgeons to pick up the skills and grow. Surgery evolved as a separate field. Introduction of Antisepsis by Joseph Lister and the use of anaesthesia in surgical practice made surgery safe and painless. Surgery shifted from being a last resort to an early intervention for the right indication.

Pain and invasion have always been a concern in the surgical patient. The 20th century saw the unseen. We could see inside the body without major cuts. The advent of optics made this possible. Newer and safer energy sources have helped perform minimally invasive surgery safely, reducing morbidity considerably. A major shift towards laparoscopy changed the face of surgery across the globe. Initially, it was used for diagnosis alone. Kurt Semm performed a laparoscopic appendicectomy in 1980.^[6] Many others joined the race, and soon Eric Muhe performed the first laparoscopic cholecystectomy in 1986. Like all new beginnings have to face resistance and criticism, the pioneers in laparoscopy also had to face a lot of challenges. Today, we see the fruits of their vision with patients benefiting the most.

As the idea of patient comfort reached every nook and corner of the world, laparoscopic surgery became a household name. People began asking for the procedures, thus compelling surgeons to proceed towards learning minimally invasive surgery (MIS). The surgeon’s comfort, meanwhile, took a backseat. With the advent of robotic surgery, this deficiency is taken care of. We have a better vision, along with the comfort of the surgeon. Robotic surgery is gaining popularity due to its 3D view, better magnification, reduced tremors and greater freedom of movement of the instruments. The major drawback is the cost. But with many players in the market, a competition has set in, and robotic surgery in every town is going to be the next change waiting to happen. It is not just that Robotic surgery is going to be the major change; a number of procedures are being performed by Robots, with or without supervision. The ‘Capsular Robots’^[7] It will transform endoscopic surgeries in the future. Telesurgery has also taken a leap. Transcontinental surgeries are routinely being performed, helping the less privileged in a remote area get the advantage of skill and technology. In future, with Autonomous surgical robots, it may be possible to perform surgery even in space where skilled personnel cannot be sent for a surgical procedure when it is required.

Cognitive augmentation with AI can help in preoperative planning, intraoperative guidance towards safer surgery by identifying crucial structures, intraoperative detection of cancer cells using Raman Spectroscopy, predicting postoperative complications, decisions regarding ICU admissions and weaning off from a ventilator, pain management and monitoring rehabilitation.^[8] The surgeon’s role may seem to be shrinking. But, instead if we consider this as an augmentation, the patient benefit is indeed going to be incredible.

AI is here and is growing by leaps and bounds. The pace at which machine learning is happening is indeed unimaginable. It is here to augment our capacity to think and act. Instead of calling it artificial intelligence, let us call it our extension, i.e., augmented human intelligence. When two brains meet, we must not consider them to be competitors, but rather facilitators of a magnum opus. With a super brain and super technology, we can perform like a superhuman with magical speed and precision. But at any given point, compassion and empathy must be the basis of any treatment we choose. In the end, let us not forget that it was for the betterment of the patient that we are all aiming. Whatever technology may be available, however skilful one may become, let the hands holding the scalpel be humble, gentle and kind!!